Postsurgical Complications following Distal Radius Volar Plating in a Diabetic Population at Short-Term Follow-up

Abstract

Background

Diabetes mellitus increases the risk of complications following operative treatment of lower extremity fractures. There is little published data establishing the impact of diabetes following surgical treatment of upper extremity fractures. This investigation aimed to compare the incidence of short-term postsurgical complications following volar locked plating of distal radius fractures in patients with and without diabetes.

Methods

A retrospective matched cohort investigation of 33 diabetics matched 1:2 to 66 non-diabetics was performed, accounting for age, gender, fracture type, and smoking status. Electronic medical records and radiographs were reviewed for all major and minor postsurgical complications. Demographic characteristics, postoperative radiographic parameters, and final range of motion were also compared. Mean follow-up was 5.3±8.2 and 5.5±7.8 months for diabetics and non-diabetics, respectively.

Results

The diabetic cohort had a significantly higher overall complication rate with 24 postsurgical complications affecting 12 patients (36 %) compared to 16 complications affecting 12 patients (18 %) in the non-diabetic cohort. There was no difference in the incidence of major complications requiring operative intervention. Minor complications were significantly more common in the diabetic group and were largely accounted for by peripheral neuritis with an incidence of 30 %. Final radiographic outcomes and range of motion were similar.

Conclusions

Diabetics experienced a greater incidence of minor postsurgical complications following volar locked plating of distal radius fractures when compared to a matched, control population. The difference in outcomes is largely accounted for by the increased incidence of peripheral neuritis among diabetics. Diabetic patients should be counseled preoperatively regarding their elevated risk profile.

Keywords

Diabetes mellitus Distal radius fracture Volar locked plating

Get full access to this article

View all access options for this article.

References

Al-Rashid

Theivendran

Craigen

. Delayed ruptures of the extensor tendon secondary to the use of volar locking compression plates for distal radial fractures. J Bone Joint Surg Br. 2006;88:1610–2.

Arora

Lutz

Hennerbichler

. Complications following internal fixation of unstable distal radius fracture with a palmar locking-plate. J Orthop Trauma. 2007;21:316–22.

Bell

Wollstein

Citron

. Rupture of flexor pollicis longus tendon: a complication of volar plating of the distal radius. J Bone Joint Surg Br. 1998;80:225–6.

Bentohami

de Burlet

de Korte

. Complications following volar locking plate fixation for distal radial fractures: a systematic review. J Hand Surg Eur Vol. 2014;39:745–54.

Chung

Shauver

Birkmeyer

. Trends in the United States in the treatment of distal radial fractures in the elderly. J Bone Joint Surg Am. 2009;91:1868–73.

Chung

Spilson

. The frequency and epidemiology of hand and forearm fractures in the United States. J Hand Surg Am. 2001;26:908–15.

Court-Brown

Caesar

. Epidemiology of adult fractures: a review. Injury. 2006;37:691–7.

Ding

Xiao

. Risk factors for postoperative wound complications of calcaneal fractures following plate fixation. Foot Ankle Int. 2013;34:1238–44.

Drobetz

Bryant

Pokorny

. Volar fixed-angle plating of distal radius extension fractures: influence of plate position on secondary loss of reduction—a biomechanic study in a cadaveric model. J Hand Surg Am. 2006;31:615–22.

10.

Dyck

Giannini

. Pathologic alterations in the diabetic neuropathies of humans: a review. J Neuropathol Exp Neurol. 1996;55:1181–93.

11.

Esenwein

Sonderegger

Gruenert

. Complications following palmar plate fixation of distal radius fractures: a review of 665 cases. Arch Orthop Trauma Surg. 2013;133:1155–62.

12.

Fernandez

Ring

Jupiter

. Surgical management of delayed union and nonunion of distal radius fractures. J Hand Surg Am. 2001;26:201–9.

13.

Grindel

Wang

Gerlach

. Biomechanical comparison of fixed-angle volar plate versus fixed-angle volar plate plus fragment-specific fixation in a cadaveric distal radius fracture model. J Hand Surg Am. 2007;32:194–9.

14.

Hakimi

Jungbluth

Windolf

. Functional results and complications following locking palmar plating on the distal radius: a retrospective study. J Hand Surg Eur Vol. 2010;35:283–8.

15.

Johnson

Cutler

Dias

. Complications after volar locking plate fixation of distal radius fractures. Injury. 2014;45:528–33.

16.

Jones

Maiers-Yelden

Marsh

. Ankle fractures in patients with diabetes mellitus. J Bone Joint Surg Br. 2005;87:489–95.

17.

Jupiter

Lipton

. The operative treatment of intraarticular fractures of the distal radius. Clin Orthop Relat Res. 1993;292:48–61.

18.

Jupiter

Marent-Huber

. Operative management of distal radius fractures with 2.4-millimeter locking plates: a multi-center prospective case series. J Bone Joint Surg Am. 2009;91:55–65.

19.

Kamath

Zurakowski

Day

. Low-profile dorsal plating for dorsally angulated distal radius fractures: an outcomes study. J Hand Surg Am. 2006;31:1061–7.

20.

Karsidag

Morali

Sargin

. The electrophysiological findings of subclinical neuropathy in patients with recently diagnosed type 1 diabetes mellitus. Diabetes Res Clin Pract. 2005;67:211–9.

21.

Knirk

Jupiter

. Intra-articular fractures of the distal end of the radius in young adults. J Bone Joint Surg Am. 1986;68:647–59.

22.

Koval

Harrast

Anglen

. Fractures of the distal part of the radius. The evolution of practice over time. Where's the evidence? J Bone Joint Surg Am. 2008;90:1855–61.

23.

Marsh

Slongo

Agel

. Fracture and dislocation classification compendium – 2007: Orthopaedic Trauma Association classification, database, and outcomes committee. J Orthop Trauma. 2007;21:S1–S133.

24.

McQueen

Caspers

. Colles fracture: does the anatomical result affect the final function? J Bone Joint Surg Br. 1988;70:649–51.

25.

Miller

Margules

Raikin

. Risk factors for wound complications after ankle fracture surgery. J Bone Joint Surg Am. 2012;94:2047–52.

26.

Nellans

Kowalski

Chung

. The epidemiology of distal radius fractures. Hand Clin. 2012;28:113–25.

27.

Nunley

Rowan

. Delayed rupture of the flexor pollicis longus tendon after inappropriate placement of the pi plate on the volar surface of the distal radius. J Hand Surg Am. 1999;24:1279–80.

28.

Orbay

Fernandez

. Volar fixation for dorsally displaced fractures of the distal radius: a preliminary report. J Hand Surg Am. 2002;27:205–15.

29.

Orbay

Fernandez

. Volar fixed-angle plate fixation for unstable distal radius fractures in the elderly patient. J Hand Surg Am. 2004;29:96–102.

30.

Osada

Viegas

Shah

. Comparison of different distal radius dorsal and volar fracture fixation plates: a biomechanical study. J Hand Surg Am. 2003;28:94–104.

31.

Ovaska

Makinen

Madanat

. Risk factors for deep surgical site infection following operative treatment of ankle fractures. J Bone Joint Surg Am. 2013;95:348–53.

32.

Rampoldi

Marsico

. Complications of volar plating of distal radius fractures. Acta Orthop Belg. 2007;73:714–9.

33.

Ricci

Streubel

Morshed

. Risk factors for failure of locked plate fixation of distal femur fractures: an analysis of 335 cases. J Orthop Trauma. 2014;28:83–9.

34.

Richard

Wartinbee

Riboh

. Analysis of the complications of palmar plating versus external fixation for fractures of the distal radius. J Hand Surg Am. 2011;36:1614–20.

35.

Rozental

Blazar

. Functional outcome and complications after volar plating for dorsally displaced, unstable fractures of the distal radius. J Hand Surg Am. 2006;31:359–65.

36.

Rozental

Blazar

Franko

. Functional outcomes for unstable distal radial fractures treated with open reduction and internal fixation or closed reduction and percutaneous fixation. A prospective randomized trial. J Bone Joint Surg Am. 2009;91:1837–46.

37.

Soong

van Leerdam

Guitton

. Fracture of the distal radius: risk factors for complications after locked volar plate fixation. J Hand Surg Am. 2011;36:3–9.

38.

Stewart

Innes

Burke

. The hand complications of Colles' fractures. J Hand Surg Br. 1985;10:103–6.

39.

Steyers

Blair

. Measuring ulnar variance: a comparison of techniques. J Hand Surg Am. 1989;14:607–12.

40.

Trumble

Schmitt

Vedder

. Factors affecting functional outcome of displaced intra-articular distal radius fractures. J Hand Surg Am. 1994;19:325–40.

41.

Vincent

Calabek

Roberts

. Biology of diabetic neuropathy. Handbook of Clin Neurol. 2013;115:591–606.

42.

Vincent

Kato

McLean

. Sensory neurons and schwann cells respond to oxidative stress by increasing antioxidant defense mechanisms. Antioxid Redox Signal. 2009;11:425–38.

43.

Ward

Kuhl

Adams

. Early complications of volar plating of distal radius fractures and their relationship to surgeon experience. Hand (NY). 2011;6:185–9.

44.

Wei

Raizman

Bottino

. Unstable distal radius fractures treated with external fixation, a radial column plate, or a volar plate. A prospective randomized trial. J Bone Joint Surg Am. 2009;91:1568–77.

45.

Wright

Horodyski

Smith

. Functional outcome of unstable distal radius fractures: ORIF with a volar fixed-angle tine plate versus external fixation. J Hand Surg Am. 2005;30:289–99.